{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Jean M Malloy","gend":1,"currentgend":"","add":"13 EMERSON ST 307","city":"PORTLAND","state":"ME","zip":"04101","dob":"1952-06-28","age":"","mstatus":"","insh":"10000055383","cliId":"","pno":2076716823,"cno":"","email":"kportldy@yahoo.com","ename":"","eno":"","pphy":"FRASER, ROBERT J","ppno":2077745816,"pcpadd":"100 FODEN RD. W,SUITE 203","pcpcity":"SOUTH PORTLAND","pcpstate":"ME","pcpzip":"41066143","pcpcounty":"","pcpid":"","pcpname":"INTERMED","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"13 EMERSON ST 307","madd2":"","madd3":"","mcity":"PORTLAND","mstate":"ME","mzip":"04101","pcpfaxno":2078741483,"pcpnpi":1134206352,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3YC0QY0XN49","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","Z98890","Z7982","Z79899","M1711","M25561","C7A011","C7B02","Z8679","C7A8","Z1211","I71019","I7771","I71010","R197","Z7189","Z515","Z1231","R911","C7A012","C259","K831","F419","E785","K5790","Z9049","Z0000","C7B8","Z23","I7102","K8689","R1011","Z0184","C7A1","R051","R932","K429","Z0100","Z86718","E039","I351","Z03818","Z8719","K635","R110","R109","R140","D122","M899","K838","C7A098","C7B09","K8590","R945","R002","M25562","K760","D3A8","D124","Z1212","T8203XA","E162","R7989","E782","I7100","E7800","Z48812","D62","I4891","J90","I77819","R0602","J9811","I7101","I7103","R232","M79671","I712","R079","I5189","R918","R072","M9900","M9901","M9902","R0789","I739","I340"],"date":["2025-11-10","2025-05-30","2025-05-30","2025-05-30","2024-02-20","2024-03-11","2025-11-04","2025-10-08","2024-12-19","2025-03-20","2023-02-22","2024-11-11","2024-11-11","2024-11-11","2025-03-20","2025-03-20","2025-03-20","2024-11-07","2022-12-15","2022-12-15","2024-11-22","2025-11-05","2025-11-05","2025-11-05","2024-11-22","2023-11-20","2024-05-08","2025-05-14","2023-11-13","2023-10-19","2023-07-14","2023-02-17","2023-10-09","2025-06-11","2025-02-11","2024-07-29","2024-11-05","2025-05-05","2024-01-17","2024-05-03","2023-11-06","2025-02-11","2024-11-05","2024-11-22","2024-07-29","2024-07-29","2023-07-14","2024-11-22","2023-06-30","2025-11-05","2024-06-06","2024-06-06","2024-07-12","2023-01-17","2024-01-27","2024-03-11","2025-10-15","2022-12-15","2024-11-22","2023-02-13","2022-11-03","2022-10-21","2022-06-30","2022-04-25","2022-04-07","2022-04-07","2022-03-16","2022-03-16","2022-03-16","2022-03-09","2022-03-09","2022-03-09","2022-02-28","2022-02-25","2022-03-04","2022-02-07","2022-02-22","2022-02-22","2022-02-22","2022-02-22","2022-02-22","2022-02-22","2022-02-25","2022-02-25","2022-02-25","2022-02-25","2022-02-22","2022-02-22"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","NEOMYCIN-POLYMYXIN-DEXAMETH","","","Select","Select",""],["","","CARVEDILOL","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","TRAMADOL HCL","","","Select","Select",""],["","","FLUARIX TRIVALENT 2024-2025","","","Select","Select",""],["","","CIPROFLOXACIN HCL","","","Select","Select",""],["","","METRONIDAZOLE","","","Select","Select",""],["","","SYNTHROID","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","FUROSEMIDE","","","Select","Select",""],["","","POTASSIUM CHLORIDE","","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}